The 57 yr old man

[FIGHT ON]

I remember the leader of a group that my friend and I hooked up with on Skyline last year. Just before flatrock area I saw her give some young guy that was sitting on the side of the trail some pills after talking to him for a moment. I didn't hear what they were talking about but according to another hiker he was aiming for he tram but turned back at flatrock because he was dehydrated and felt crummy. Said she gave him some salt tablets. He looked around 25 and I thought he just didn't read the Cy link and ran out of water. He was hiking alone.
Yesterday my friend and I did Skyline again and ran across a group of four who were stopped just before the traverse. Laying flat on his back was this 57 yr old man. Doug said he was recovering from leg cramps and would soon be ok because two other hikers that had just passed gave him some pills.
Now I am wondering what these pills are so he says they were electrolyte pills.
I caught up with those two hikers that helped him and they said the same thing. They were experienced hikers and always carry them.
At the top of the trail Doug was hiking fine and feeling great.
I asked him what happened and he really couldn't figure it out. He hikes regularly and has for many years and this is the first time that it had happened to him. He had done this Skyline many times before. So many that he could not give me a number. "Lost count". The other three in his group were less than 45 year old so I was thinking maybe he was trying to keep up with them. I asked what he ate or didn't eat the day before and he said nothing different than he has in the past. He drank plenty of water during the hike but w/o additives like added salt. Maybe that's it. Maybe it's just this hike.
He did say that his leg cramps were so severe that he could not move. That they tried several times to get up and go after several 10 minute breaks but legs just froze up.
He said that if it weren't for those pills he would have had to be carried out by SAR. Wow. Looks like this could happen to anybody regardless of age or fitness. Hard to imagine being out on some hike and my legs are paralyzed. Has anyone seen this happen on other trails?
Seems almost every hike I go on or trip report I read I learn of something new that can go wrong.
My pack is going to explode from all the things I'm carrying now.
I am definitely going to carry them now and not just for my self but for anyone else I see that needs them.

[Ellen]

Howdy Fight On,

I suspect the man with leg cramps was suffering from heat cramps. Heat cramps are caused by a fluid/sodium imbalance in the muscles. Unlike hyponatremia (low blood sodium) Individuals with heat cramps usually have normal blood sodium levels.

Heat cramps are generally caused by excessive loss of sodium. The concentration of sodium in sweat sodium averages about 805 mg per quart (two pounds of sweat). If a person is a salty sweater (loses more salt than normal in sweat) or a heavy sweater (has a high sweat rate), they are at greater risk of heat cramps.

How do you know if you're a salty sweater? The sweat stings the eyes and you have patches of white on your shirt at the end of a hike.

How do you know if you have a high sweat rate? Do a sweat rate test.
More on that in another post.

Individuals who normally don't cramp during regular hikes in the shady, cooler mountains can experience cramps on Skyline due to greater sweat losses (the hike is both hard and hot).

Prevention of heat cramps:

1) Replace the sodium losses as well as water losses. As noted above, the average sweat sodium loss is about 800 mg for every quart of sweat.
2) You have many options for replacing sodium losses while hiking:
a) Use a sports drink that contains a higher amount of sodium such as Gatorade Endurance or PowerBar Endurance.
b) Add table salt to your water. To get 800 mg of sodium per quart, use slightly less than 1/2 teaspoon of table salt. One teaspoon of table salt supplies 2000 mg of sodium and 3000 mg of chloride.
c) Use sports gels that contain higher amounts of sodium. Many PowerBar gels have 200 mg of sodium per gel.
d) Carry salt tablets. These are available at most pharmacies such as CVS, Rite Aid, Walgreens. A standard salt tablet has 1000 mg of sodium. You can also buy lower dose salt tablets over the internet as well as at REI, etc. I do not recommend Hammer Endurolytes as one pill only has 40 mg of sodium.
e) Carry fast food salt packets. I believe each packet has 1/4 teaspoon of salt (500 mg of sodium).
f) Carry salty snacks -- pretzels, nuts, baked chips, jerky, etc.
3) Adequate water must be consumed with salt. Otherwise, you can get sick to your stomach due to an osmotic imbalance in your intestine.
4) Be like Z-dude: Salt your food generously and drink ample fluids the day before hiking Skyline. Of course, attaching a bungee cord to Z-dude, Perry, Scott Scott, Alan K, Andy, etc. would help too.
My cramping story: I once hiked Skyline when the starting temperature was 100 F (stupid, stupid, stupid)! I carried regular Gatorade (440 mg of sodium per quart). It took us around nine hours. When I went to the ladies room at the tram, I experienced such intense leg and abdominal cramps while sitting down that I thought I'd be trapped in the john.

Miles of smiles,
Ellen

[zippetydude]

Hiker: Ow! I've got a short circuit in my sarcoplasmic reticulum! Can someone help me restore my osmotic balance?

Translation: Ow! Cramp! Got salt?

Your post made me curious what causes cramps, so I looked it up. Now I know more than I ever thought I would!

I'm not one of those "Ten Essentials" guys, (in fact, I carry as little as possible) but I do carry salt caps. I figure the value/weight ratio in them is about as high as it gets. Added value tip: If you finish Skyline and find little salt granules all over your face, neck, etc., you can recycle them! (Sick, just kidding.)

I've seen people in marathons have trouble many times, especially on hot days.

For most of us, hyponaetremia is not a very big risk, but here's a Wiki link .

http://en.wikipedia.org/wiki/Hyponaetraemia

I intentionally indulge in extra salty food the night before a race or a Skyline trip. Mmmm.

See you out there.

z

[zippetydude]

I'm not really replying to myself here - Ellen and I replied at almost the exact same time. HJ and I do that as well, apparently there's some cosmic link that comes with trail induced dementia...

Ellen, I have a question. Why would one be a salty sweater? Does that indicate excessive sodium intake, or is it genetically predetermined? It doesn't seem like the body should have options there, but I can tell you that I show a whole lot more salt at the end of an ultra than most people. Even Mt. Whitney can do it to me, and it's too cold there to sweat a lot. Anyway, just wonderin'.

z

[FIGHT ON]

Hey z. People who have CF have way a lot of salt in their sweat. I'm not saying you have it but people that do are genetically predetermined.

[Rick M]

Interesting. This past Saturday we were prepping our rocket motor out in the Mojave. No strenuous hiking but in the sun the whole time working and only lots of water to drink and I didn't eat anything since we were pressed for time. By 4pm I was feeling over all not too good and just wanted to sit down . I went digging in the truck and pulled out a quart of Gatorade . Half hour later I was feeling much better .

ps Our quarter scale motor blew up...back to the drawing board

[Hikin_Jim]

When I went to the ladies room at the tram, I experienced such intense leg and abdominal cramps while sitting down that I thought I'd be trapped in the john.

San Jacinto, disabled, stranded in small rooms ... am I beginning to see a pattern here?

Wow, in reading your recommendations, that seems like a lot of salt. Adding just one of those little fast food packets of salt in 1 qt. of water seems like it would be pretty nasty tasting. I've always assumed that I was getting plenty of salt from the cytomax + processed foods that I typically bring (bread, trail bars, etc.). I may need to review that because I know I'm a salty sweater (salt stains all over my backpack and shirts) and I think I sweat more than the average person. I still feel dehydrated after a long hike on a hot day although I don't have that aching that I used to have before I started taking along sports drinks. I'll look forward to reading more about that sweat rate test that you're talking about.

QUESTION ABOUT SALT TABLETS: Are there any down sides? I know that the Army used to issue salt tabs but that they stopped I believe for "health reasons." I know salt tends to raise blood pressure which is something I personally have to keep my eye on. Is there a situation where "too much of a good thing" could get one in trouble? Due to excercise, one's heart rate would already be high and therefore I would assume one's BP would also be high. Could one over do it with the salt and wind up with a high BP related injury/problem? Any other downsides to overly high salt/electrolyte intake?

[Ellen]

Howdy Z,

Consuming more salt does increase the salt content of sweat. This doesn't necessarily mean, however, that you should decrease your salt intake.

Heat acclimation (which takes 7 to 10 days) reduces the amount of salt lost in sweat and increases the amount one sweats, which aids in evaporative cooling.

Salty sweaters can lose 1600 mg of sodium per quart of sweat -- twice the normal amount lost in sweat (800 mg per quart).

As Fight On pointed out, people with cystic fibrosis (CF) have salty sweat.
Also, people who have a recessive gene for CF (1 of 20 people of northern and central European descent) also lose more salt in their sweat.

Howdy Jim,

You are hilarious -- I didn't consider the similarity between those two events.

You appear to be consuming enough salt through your sports drink and salty snacks. I think the people who cramp on Skyline only drink water and don't have salty snacks.

The down side of consuming too much salt during exercise -- gastrointestinal distress and bloating. One friend said he swelled up like a tick. He was using salt tablets on the marathon in the Ironman and didn't drink enough water. He also had never used salt tablets in training.

Sedentary Americans do consume too much sodium. A high salt intake does increase blood pressure in those who are salt sensitive. I think it's reasonable to moderate salt intake during the week when you aren't sweating alot.

I've never heard of a case where consuming salt during exercise dangerously increased blood pressure. Stimulants such as citrus aurantium and ephedra can definately increase blood pressure to dangerous during exercise.

Miles of smiles,
Ellen

[Ellen]

Howdy Z,

Consuming more salt does increase the salt content of sweat. This doesn't necessarily mean, however, that you should decrease your salt intake.

Heat acclimation (which takes 7 to 10 days) reduces the amount of salt lost in sweat and increases the amount one sweats, which aids in evaporative cooling.

As Fight On pointed out, people with cystic fibrosis (CF) have salty sweat.
Also, people who have a recessive gene for CF (1 of 20 people of northern and central European descent) also lose more salt in their sweat.

Howdy Jim,

You are hilarious -- I didn't consider the similarity between those two events.

You appear to be consuming enough salt through your sports drink and salty snacks. I think the people who cramp on Skyline only drink water and don't have salty snacks.

The down side of consuming too much salt during exercise -- gastrointestinal distress and bloating. One friend said he swelled up like a tick. He was using salt tablets on the marathon in the Ironman and didn't drink enough water. He also had never used salt tablets in training.

Sedentary Americans do consume too much sodium. A high salt intake does increase blood pressure in those who are salt sensitive. I think it's reasonable to moderate salt intake during the week when you aren't sweating alot.

I've never heard of a case where consuming salt during exercise increased blood pressure. Stimulants such as citrus aurantium and ephedra definately increase blood pressure during exercise.

Miles of smiles,
Ellen

[Rob]

I know that the Army used to issue salt tabs but that they stopped I believe for "health reasons."

Similarly, in the olden days, the Navy had salt tablet dispensers in boiler rooms so that firemen could pop salt tablets like candy. I think those dispensers vanished by 1980.